White patches in the mouth, sometimes painful, often painless, are most commonly symptoms of thrush, and less commonly symptoms of oral hairy leukoplakia.
White patches along the tongue and occasionally in adjacent areas in the mouth are symptoms not only of thrush, but also of oral hairy leukoplakia (OHL). Oral hairy leukoplakia is named for its location in the mouth (oral), and its appearance as white patches (leukoplakia) with microscopic hairlike protrusions (hairy) from the tongue’s surface. The patches can be a fraction of an inch in diameter or they can coat most of the tongue. Some people with oral hairy
leukoplakia have a sore mouth and occasionally have voice changes.
The symptoms of OHL resemble the symptoms of thrush, though OHL is somewhat less common. Sometimes the first clue to a diagnosis of OHL is that the person does not respond to treatment for thrush. The best way to distinguish clearly between thrush and OHL is to look at tissue taken by biopsy under the microscope. Often the patch itself is sufficiently distinctive in appearance to make a biopsy unnecessary. Most people discover the patches themselves, when they examine their mouths.
Oral hairy leukoplakia is a rather unusual condition. Its cause is unknown, but may have something to do with the Epstein-Barr virus, the virus responsible for infectious mononucleosis. Whatever the association with the Epstein-Barr virus, OHL is not considered contagious. It is found only in people with HIV infection and no one else gets it.
There is little need for treatment except for pain, for interference with nutrition, or for voice changes. The usual treatment is an antiviral drug, acyclovir, taken by mouth. Occasionally other antiviral drugs like ganciclovir are also successful. The patches disappear within two or three weeks when treated, but like thrush, they recur when the medicine is discontinued.
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